Healthcare Provider Details

I. General information

NPI: 1437228715
Provider Name (Legal Business Name): NIA IRENE MENSAH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIA IRENE TOOMER

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1020
ATLANTA GA
30308-2247
US

IV. Provider business mailing address

100 W. 141ST ST #68
NEW YORK NY
10030
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-3467
  • Fax:
Mailing address:
  • Phone: 770-631-8277
  • Fax: 770-631-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008840
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02-9911-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: